Nivolumab and Degarelix with or without BMS-986253 in Treating Patients with Hormone-Sensitive Prostate Cancer
This phase Ib/II trial studies the side effects and how well nivolumab and degarelix with or without BMS-986253 work in treating patients with prostate cancer that is sensitive to hormone therapy. Immunotherapy with monoclonal antibodies, such as nivolumab and BMS-986253, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Testosterone can cause the growth of prostate cancer cells. Drugs, such as degarelix, may lessen the amount of testosterone made by the body. It is not yet known whether giving nivolumab and degarelix with or without BMS-986253 will work better in treating patients with hormone-sensitive prostate cancer.
Inclusion Criteria
- Histologically documented prostatic adenocarcinoma confirmed by a pathology report from prostate biopsy or a radical prostatectomy specimen
- Age >= 18 years
- Previously undergone primary therapy for prostate cancer. Salvage radiation therapy (XRT) or cryotherapy following primary therapy >= 6 months prior to randomization is allowed.
- A rising PSA defined as the following: * If the subject’s primary therapy was RP (with or without adjuvant or salvage XRT), rising PSA is defined as 2 consecutive rising values above 0.2 ng/mL, each taken >= 3 weeks apart, and the last value >= 2.0 ng/mL * If the subject received other primary therapies (e.g. XRT, cyrosurgery, brachytherapy), rising PSA is defined per the Phoenix definition, i.e., 2 consecutive rising values above the PSA nadir plus 2.0 ng/mL
- For the biopsy sub-groups, patients must be willing to undergo pre and on-treatment biopsies
- PSA doubling time (PSADT) =< 12 months. PSADT will be determined from all non-zero PSA values collected preferable, however not limited to, from the 12 months prior to randomization. To calculate PSADT, there must be at least THREE PSA values, with at least 4 weeks between each measurement. The PSADT will be computed from the formula: PSADT = (loge2)/k, with k being the estimated slope of the logarithm of PSA over time
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1, or Karnofsky score >= 70%
- Testosterone >= 150 ng/dL =< 28 days of prior to registration
- White blood count (WBC) > 3,000 cells/mm^3
- Absolute neutrophil count (ANC) > 1,500 cells/mm^3
- Hemoglobin > 9.0 g/dL
- Platelet count > 100,000 cells/mm^3
- Serum creatinine < 1.5 x upper limit of normal (ULN)
- Serum total bilirubin < 1.5 x ULN
- Alanine aminotransferase (ALT) < 3 x ULN
- Aspartate aminotransferase (AST) < 3 x ULN
- Willingness to provide written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization for the release of personal health information, and the ability to comply with the study requirements (note: HIPAA authorization will be included in the informed consent)
- Willingness to use barrier contraception during treatment plus 5 half-lives of nivolumab (~125 days) plus 90 days (duration of sperm turnover) for a total of 215 days post-treatment completion (azospermic men are not exempt from contraceptive requirements)
Exclusion Criteria
- Received any experimental immunotherapy on an experimental clinical trial =< 1 year prior to registration
- PSA > 50 at time of enrollment
- High volume disease defined as > 5 bone metastases or lymph nodes > 3 cm in size
- Histologic predominance of other types of prostate cancers such as sarcomatous, lymphoma, small cell, and neuroendocrine tumors (note: a maximum of 5 subjects with ductal prostate cancer will be allowed to enroll to each arm of study treatment across all sites)
- Received salvage XRT =< 6 months prior to randomization
- Received ADT =< 6 months prior to randomization
- Received any form of chemotherapy =< 90 days prior to randomization
- Received granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor (GM-CSF) =< 90 days prior to randomization
- Any major surgery requiring general anesthesia =< 28 days prior to randomization
- Any other concurrent or prior treatment for prostate cancer =< 28 days prior to randomization
- An active infection requiring parenteral antibiotic therapy or causing fever (temperature > 100.5 degrees Fahrenheit [F] or 38.1 degrees Celsius [C]) within 1 week prior to randomization
- Prior systemic, ongoing immunosuppressive therapy =< 14 days prior to study treatment administration (except for adrenal replacement steroid doses =< 10 mg daily prednisone equivalent in the absence of active autoimmune disease or a short course of steroids [< 5 days] up to 7 days prior to initiating study treatment)
- Prior participation in an anti-IL8 clinical study
- A candidate is scheduled or likely to be scheduled for salvage external beam XRT or surgery for prostate cancer during the study period
- Concomitant treatment with other hormonal therapy or 5 alpha-reductase inhibitors such as dutasteride or finasteride (prior use of these agents is allowed if >= 3 months prior to randomization)
- History of known or suspected autoimmune disease with the following exceptions: * Asthma and/or allergic rhinitis (seasonal allergies) * Vitiligo * Resolved childhood atopic dermatitis * Psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger * Residual hypothyroidism due to an autoimmune condition only requiring hormone replacement * Euthyroid participants with a history of Grave’s disease (participants with suspected autoimmune thyroid disorders must be negative for thyroglobulin and thyroid peroxidase antibodies and thyroid stimulating immunoglobulin [Ig] prior to the first dose of study treatment) * Type 1 diabetes mellitus
- History of malignancy within the last 2 years (except non-melanoma skin cancers and superficial bladder cancer) and for which no additional therapy is required or anticipated to be required during the study period
- Uncontrolled major active infectious, cardiovascular, pulmonary, hematologic, or psychiatric illnesses that would make the patient a poor study candidate
- Known prior or current history of human immunodeficiency virus (HIV) and/or hepatitis B/C
- Prior organ allograft
Additional locations may be listed on ClinicalTrials.gov for NCT03689699.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVES:
I. Determine the rate of prostate-specific antigen (PSA) recurrence defined as a PSA > 0.2 ng/ml for radical prostatectomy patients or PSA > 2.0 ng/ml for patients who received other primary therapies (e.g. radiation, cryotherapy, brachytherapy) at a time point of 10 months after start of therapy.
II. Determine the safety and tolerability of either nivolumab or nivolumab plus anti-IL-8 monoclonal antibody humax-IL8 (BMS-986253) in combination with degarelix in men with hormone-sensitive prostate cancer.
SECONDARY OBJECTIVES:
I. To assess the relapse-free survival (RFS) after recovery of testosterone with relapse defined as a PSA > 0.2 ng/ml for radical prostatectomy patients or PSA > 2.0 ng/ml for patients who received other primary therapies and recovery of testosterone defined as a testosterone (> 150 ng/dl).
II. Determine the RFS with relapse defined as a PSA > 0.2 ng/ml for radical prostatectomy patients or PSA > 2.0 ng/ml for patients who received other primary therapies.
III. Determine the time to PSA > 5.0 ng/ml after start of therapy.
IV. Determine the time to recovery of testosterone in all arms of the study and measured as the time from start of therapy to the time of testosterone recovery, defined as a testosterone level > 150 ng/dl.
V. Determine the time to next anti-cancer treatment in all arms of the study and measured as the time from start of therapy to the time of next treatment.
VI. Determine the rate of metastatic progression 10 months after start of therapy.
VII. Determine the percent (%) change in PSA to immunotherapy by comparing the PSA prior to and following 8 weeks of immunotherapy and before initiation of androgen deprivation therapy (ADT).
VIII. To compare the rate of PSA recurrence at 10 months following start of therapy, RFS, RFS after recovery of testosterone, time to recovery of testosterone, time to next anti-cancer treatment and rate of metastatic progression 10 months after start of therapy between patients treated with nivolumab plus degarelix versus patients treated with nivolumab plus BMS-986253 plus degarelix.
EXPLORATORY OBJECTIVES:
I. To assess the anti-tumor immune response.
Ia. Quantification of CD8 T cell, CD4 T cell, regulatory T cells (Treg), CD8/Treg, CD4/Treg, polymorphonucler-myeloid-derived suppressor cells (PMN-MDSC) and other immune cell populations in a subset of patients (at least 10 per arm) with tumor specimens before and after treatment by immunohistochemistry (IHC).
Ib. Quantification a range of immunologic markers in a subset of patients (at least 10 per arm) with tumor specimens before and after treatment.
Ic. Quantification of tumor cell apoptosis by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling assay (TUNEL) and caspase-3 staining.
Id. Quantification of circulating IL-8 and other cytokines before and after treatment and correlation with response to therapy.
Ie. Quantification of circulating PMN-MDSCs and other immune cell populations before and after treatment and correlation with response to therapy.
If. Assess whether treatment can induce an increased immunoglobulin G (IgG) response to tumor antigens (epitope spreading) by comparing pre- and post-treatment sera.
Ig. Assess the deoxyribonucleic acid (DNA) or ribonucleic acid (RNA)-related molecular characteristics of tumor specimens and correlate with response to treatment (if adequate tissue available).
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients receive nivolumab intravenously (IV) over 30 minutes on day 1. Treatment repeats every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive nivolumab IV over 30 minutes and degarelix subcutaneously (SC) on day 1. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive anti-IL-8 monoclonal antibody humax-IL8 IV over 120 minutes on days 1 and 15, and nivolumab IV over 30 minutes on day 1. Treatment repeats every 28 days for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive anti-IL-8 monoclonal antibody humax-IL8 IV over 120 minutes on days 1 and 15, nivolumab IV over 30 minutes on day 1, and degarelix SC on day 1. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 100 days, every 2 months for 1 year and then every 3 months for 1 year.
Trial PhasePhase I/II
Trial Typetreatment
Lead OrganizationNYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
Principal InvestigatorMatthew Dallos
- Primary IDAAAR7949
- Secondary IDsNCI-2019-00534
- ClinicalTrials.gov IDNCT03689699